When Trauma In Kids Looks Like Something Else

Jan 27, 2017

WWNO’s Education reporting continues to explore the theme: “Kids, Trauma and New Orleans Schools.”

Dr. Denese Shervington is CEO of the Institute of Women and Ethnic Studies. You may have seen the group’s billboards or social media posts on how New Orleans kids are “Sad, Not Bad.”

WWNO’s Eve Troeh and Mallory Falk talked to the mental health expert about how trauma in the city’s children not only goes unrecognized – it’s misdiagnosed.

MALLORY FALK: Our series has focused on how trauma shows up in the classroom. What are some of the behaviors that might result from being exposed to trauma but that might appear to teachers as something else?

DENESE SHERVINGTON: I think the most important symptom that might show up in a kid is hyperactivity and lack of attention.

EVE TROEH: And so to a teacher, they might be experiencing that. What do they think the source of that is?

SHERVINGTON: Oftentimes they are just focusing on the behaviors and they might not have the expertise or the time to dig more deeply, to understand why is this kid being hyperactive, why is this kid not paying attention.

FALK: If the teacher does then refer that student outside of the classroom to a social worker or a psychiatrist, what kind of process might that trigger?

SHERVINGTON: Well if the child ends up seeing I’m gonna say a psychiatrist, ‘cause I’m one, seeing a psychiatrist, then the psychiatrist should spend in the initial visit from 60-90 minutes really getting the story and the context of this child’s life and how the behaviors are turning out. Unfortunately what tends to happen with poor people, people of color oftentimes, who can’t afford to see high quality mental health providers, not enough time is spent with the child. The focus, just like happened in the classroom, is only on the behavior. And the child more than likely is going to get diagnosed with a behavioral disorder like a conduct disorder or oppositional defiant disorder or with attention deficit hyperactivity disorder.

TROEH: ADHD.

SHERVINGTON: ADHD.

TROEH: We hear that acronym a lot. And actually in Louisiana we have one of the highest rates of children who are prescribed medication for ADHD in the nation. Is that right?

SHERVINGTON: Yes. That’s correct. The diagnosis should never be made until you have ruled out post-traumatic stress disorder. And we have the perfect storm here in New Orleans. 11 years ago we had an extreme catastrophic disaster. And even children who were not necessarily born, they themselves can be affected by the disorder ‘cause their parents will either pass that on biologically or through some of their own behaviors. So in fact one of the schools that we’ve been working with, the principal talked about her third grade class as being really, really high energy with a lot of acting out behaviors. And she thought that in some ways was connected to Katrina. She called them, these are the Katrina babies. They were born just about the time. So we have a natural disaster that happened. We have a lot of community violence and trauma. And all of these are potential stressors and triggers for young people developing post-traumatic stress disorder.

FALK: What are the consequences of not catching post-traumatic stress disorder and instead diagnosing ADHD or a behavioral disorder and proceeding with treatment that way?

SHERVINGTON: Well we’re not treating the child. We’re not treating the underlying cause and issue that’s causing their behaviors. Oftentimes in ADHD the go-to is drug treatment. In PTSD the go-to is talking therapy. And we’re exposing them to these drugs at a very early age. We don’t exactly know what that’s going to do to the brain. And also I think we are setting up a pattern in this child that when you have problems, you use drugs. And I think that when we don’t have to do that with a child, we shouldn’t.

TROEH: You’ve talked to us about seeing children’s files and reading through and recognizing almost immediately that PTSD was probably the problem and yet that had not even been explored. What were you seeing, exactly?

SHERVINGTON: I’ll think of one of the last cases that I saw. A young man was affected by Katrina. He relocated to someplace very far away. I don’t want to give any identifying information. And so he was gone for many, many years with his father. His father got involved in the criminal justice system. And so he’s returned to New Orleans. He actually at one time was suicidal so he wanted to harm himself. He went to one of the hospitals here. They did not pick up PTSD. They gave him another diagnosis. I was asked to see him and when I screened him he actually endorsed every symptom and was writing little notes to me to explain the source of his trauma. And I see this repeatedly in my work in the schools.

TROEH: You spend a lot of time in schools. You’ve had a lot of chances to see what isn’t working and what is working. If you could change one or two things that schools are doing, in light of the levels of trauma that New Orleans kids have experienced and continue to experience, what would those key changes perhaps be?

SHERVINGTON: I think teachers are the first line of support, loving support and compassion, for children in schools. So what I would continue to work on is increasing teachers’ capacity to at least recognize the emotional component of children’s behaviors and then allow them the permission to be able to figure out is there something they can do or do they need to bring in outside intervention – the social worker in the school or to get the child referred for more intense clinical intervention. And the second thing I would do would be to try to get more school mental health workers. Ultimately teachers’ role in the school is to do instruction and not to be mental health professionals.

TROEH: Dr. Shervington, thank you so much for your time.

SHERVINGTON: Thank you.

"Kids, Trauma and New Orleans Schools" was produced with support from the Center for Health Journalism at the USC Annenberg Schools for Communication and Journalism.

Support for the Education Desk at WWNO also comes from Entergy.